Total atrial paralysis after permanent dual chamber cardiac pacing

A 73 year old woman with known ischaemic heart disease and ischaemic ventricular tachycardia underwent temporary dual chamber pacing as part of the treatment to suppress tachycardia. Insertion of a permanent dual chamber system seven days later was uncomplicated. Total atrial paralysis, with inability to pace the atrium or obtain an atrial electrocardiogram from four atrial sites, developed within 24 hours of the permanent system being implanted. Atrial electrical and mechanical function recovered over several weeks.